Androgenetic Alopecia: Diagnosis and Management

00:01 Okay. So that's the pathophysiology.

00:04 What are the clinical manifestations. Well duh.

00:06 Everyone here can tell me what the manifestations are.

00:09 You've seen it in the world.

00:11 It's advertised on TV regularly.

00:13 So hair loss can begin at any time after puberty.

00:17 This is because that's at the point where you're having more testosterone and therefore making more dihydrotestosterone.

00:24 And then it will progress over a patient's lifetime.

00:27 The pattern is very characteristic.

00:31 It can be vary from individual to individual.

00:33 But in general you typically see kind of temporal loss.

00:38 And you see the male, the classic male pattern balding which on the next slide we'll see also involves the occiput of the head.

00:46 Why that pattern? Well, in fact those hair follicles have a higher density of the receptor.

00:53 That's why you lose hair in that particular location.

00:55 In fact, these individuals don't lose hair over their eyebrows.

00:58 They don't lose hair over their face or hair in their pubic area or in their axilla.

01:04 But they're losing in that location because of a higher density of the receptor.

01:08 And that's why those hair follicles are more susceptible.

01:11 And then as you go more and more it goes beyond mid temporal hairline up here.

01:16 And then we get to the vertex the occiput up at the top of the head.

01:21 You can preserve the hair down along the neck.

01:25 And that's actually really important for therapy as we'll come back to at the very end of this talk. There's also a visible reduction in hair density.

01:33 That's because the follicles are getting more and more to that vellus. That looks very fine hair kind of look. So you see many apparently fewer hair follicles.

01:45 They're actually there.

01:47 And that's how some of our therapy can also be effective if we get things back into antigen phase out of that kind of persistent global winter catagen phase.

01:58 The diagnosis. It's kind of by inspection.

02:01 But we can also do histology.

02:03 And when we do this on histology what we see is a lower density of of follicles that are in the antigen phase. And we see more in a catagen phase.

02:13 What's circled on this slide on the left hand side are follicles that are in catagen.

02:19 The hair is still there.

02:20 The hair shaft is still there.

02:22 But it's in that degenerative phase, regressive phase of the hair cycle.

02:28 And then we see we see empty follicles down on the right hand side where we have been in telogen, and the hair has actually fallen out.

02:37 What do we do about this other than embrace it? Be like Michael Jordan, shave our heads.

02:42 Well, there are other ways to.

02:44 So the first line therapy are things to reduce or to inhibit the enzyme, the five alpha reductase that's responsible for making the dihydrotestosterone the DHT.

02:56 And that will help inhibiting the follicular miniaturization, the follicular degeneration, the increase in the catagen phase.

03:05 We can also give minoxidil, and that's a vasodilator that increases the duration of antigen. So you change that ratio antigen and antigen to more antigen.

03:15 It will shorten the telogen and hopefully will restore some hair growth.

03:19 And it does work. Again remember the follicles are still there.

03:24 They're just in this phase where they're not actively synthesizing hair.

03:27 So what are your other options if you don't want to go the chemical route or the pharmacologic route? Hair transplant surgery actually works remarkably well.

03:36 And you would think, oh my God, I'm putting a tree into a desert.

03:39 Well, no. Not really. Remember, even the follicles that are not putting out hair are still present and quite viable.

03:48 They just happen to have too great a density of receptors.

03:51 So if we take hair follicles with lower density receptors, say, off the back of your neck and transplant it up here, then they will happily grow.

04:00 And that's the basis by which we do hair transplant surgery.

04:04 You can also do low level laser light therapy.

04:07 That's basically doing the same thing more or less, that minoxidil does in terms of driving improved vasculogenesis, but also increasing the number of follicles that are going to be in the antigen versus the catagen phase. There is a time tested and traditional route of using a hairpiece or comb overs. So those are all kind of our other options.

04:32 You don't need to go around with a bald head.

04:36 But again, some people just embrace that.

04:38 And that's also a very viable strategy.

04:42 With that, we will close on our topic of entropy.

04:45 Androgen associated alopecia.

04:47 And I hope that you've learned something important that your patients will appreciate being told about in the future.